[The most important factor for active urinary stone formation in patients with urolithiasis].
BACKGROUND
Urolithiasis, which affects 1-5% of western world population causing significant morbidity, is heterogeneous disorder with varying pathophysiologic milieu. Patients with recurrent stone formation are the particular problem because the understanding of the risk factors for active stone formation is deficient. The aim of the present study was to determine the most important metabolic and clinical parameters for active stone formation in order to recommend the best preventive therapies.


METHODS
In this study 134 consecutive outpatients (57 males, 46.9+/-14.4 years old) were referred and evaluated for urinary stone disease at our Institute. Clinical and metabolic parameters were determined by standardized procedures of questionnaire, serum biochemical profiles and urinalyses. An active stone former group was defined by an increase in the size or number of stones, or a recurrent stone event within 2 years.


RESULTS
In the evaluated cohort, 51 patients (38.1%) created the active stone former group. These patients were younger in the moment of the first stone elimination, had higher serum creatinine concentration, lower urine citrate concentration, as well as citrate/calcium ratio, higher urine pH and more frequently had clinical important urine sediment with eritrocituria and lenkocituria compared to the non-active stone group. Significant positive correlations were found between the active stone former and serum creatine concentration (r=0.227), urine pH (r=0.223), urine sediment (r=0.255) but negative with urine citrate (r=-0.275) and citrate/calcium ratio (r=-0.227). However, multivariate analysis indicated that clinical important urine sediment with eritrocituria and leuokocituria (p=0.033) and low urine citrate (p=0.04) were the only determinants of active urinary stone formation.


CONCLUSIONS
Further study is required to investigate efficacy of alkaline citrate substitution and rigorous diagnosis and treatment of infections in order to prevent urinary stone recurrence.
Simić-Ogrizović
Sanja
S
Institut za urologiju i nefrologiju, Klinicki centar Srbije, Beograd. dst@Eunet.yu
Dopsaj
Violeta
V
Jovicić
Svetlana
S
Milenković
Dragica
D
Jovanović
Dijana
D
Nesić
Vidosava
V
D000293:Adolescent; D000328:Adult; D000368:Aged; D019343:Citric Acid / Q000097:blood / Q000652:urine; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012307:Risk Factors; D014508:Urea / Q000097:blood; D014545:Urinary Calculi / Q000378:metabolism*; D014556:Urine / Q000166:cytology
D019343:Citric Acid; D014508:Urea; D003404:Creatinine